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Reactive Attachment Disorder at School

Students with Reactive Attachment Disorder often need a unique plan to help find them success at school. This post aims to help bring understanding and ideas to support your students with Reactive Attachment Disorder.

What it can look like-

Superficially charming. Never real. Always fake. Good enough to fool people who don’t know them well. Used extensively for manipulation purposes. Examples: I love you mommy, all super sweet, after being verbally and physically abusive to mommy for days because RAD just realized they want something only mommy can give to them. Or, charming the pants off of a stranger, then telling their “poor orphan” story so the person will feel sorry for them then buy or give them what they want.

Lack of eye contact. They will not engage unless they want something. They will only have direct eye contact when they want something from you and they are trying to gauge your reaction to their request or behavior. If you begin a conversation with them they will look everywhere except at you.

Indiscriminately affectionate with strangers. Ours point blank told us that they trusted the stranger they met that afternoon more than they trusted us, their parents. Hugging and snuggling with complete strangers within moments of meeting them is very common. Stroking other people including their hair and rubbing their hands over the strangers back and shoulders. They will grab and hold hands. They have ZERO natural boundaries. In fact this was a symptom of RAD we were unaware of when we met our RAD’s who were overly affectionate with us immediately upon meeting us. Red flag.

Not affectionate on parents’ terms. Only when RAD wants something will they say things like I’m sorry, I love you, or show any signs of affection including using terms such as mom or dad. I learned that when I heard one of them say “mom” to be on alert because they were attempting to manipulate me. Sometimes we gave in on something they wanted simply to see a glimpse of the child/teen we thought they were all the while knowing once they get what they want they will go back to their same bad behavior and we will be disappointed once again.

Destructive to self, others, animals, and material things. I could write a book about this – oh wait! I did! Self-harming is something many RAD’s do, many times to gain attention. Above all else they want all attention focused on themselves. We found the majority of the destruction from our RAD’s was aimed at hurting mom who they viewed as the enemy. Anything mom cared for became a target. That included biological children, pets, or anything that’s important to mom. If I buy the puppy a new toy it is sure to come up missing within hours. If my bio daughter gets a new notebook for school something of hers will go missing or the new notebook will have slits through it from a knife. Nothing is sacred. As mom I am very careful to what or whom I pay any special attention because there will be repercussions. If there is a baby or toddler in the home they need to be watched 24/7 to keep them from being harmed.

Cruelty to animals. RAD’s can be very cruel. They love to torment those who are weaker than they are to show their superiority, and even more so if this animal is one that I, their enemy, shows any affection whatsoever. One woman who rescued cats found her adopted daughter throwing the cats against the wall to see it they would break. They did. Many of them died. There was zero remorse. She thought it was funny. And when she saw her mom crying it made her even happier.

Lying about the obvious. Here is an example that happened over and over again in our home. I see RAD take something that doesn’t belong to them. I tell them to put it back because it isn’t theirs. RAD states they didn’t take it even though it is in their hand. I say there it is right in your hand. This will go on forever unless you threaten to take something of theirs from them. No amount of reasoning will do anything except add to the frustration. After putting up camera’s in my home office to keep them from stealing we showed them the video’s of them going into my purse and taking money. They all denied it vehemently even though the video clearly showed them putting the money into their pockets. They were so angry that we accused them that they slammed out the front door and we didn’t see them until the police brought them home three days later. Then adding insult to injury when brought home they told the police they ran away because we were stealing their money.

Stealing. Constant. Anything of perceived value. From us. From school mates. From teachers. From stores. From gas stations. From friends. From strangers. With zero remorse or admittance even when caught. On the other hand when someone steals something from them (which happened to one of our RAD’s at school). After he noticed that $5 was taken from his jacket he blew up and screamed profanities until he had to be physically restrained and I was called to pick him up where he continued to scream at me about his $5. This was the same boy who stole hundreds of dollars from us. When I attempted to help him empathize with us who he had stolen from he simply told me it was not the same and continued to rant for hours about his $5.

No impulse controls. What they want, they take. What they want to do, they do. They care nothing about consequences and in fact will be surprised if caught and then mad they got caught for something they think is no big deal. They completely turn the tables until everything, including what they did, is someone else’s fault. It is narcissism gone wild. They can only think about themselves and what they want. You cannot reason with this mentality.

Lack of conscience. As stated in several examples above, they have no reality of anything ever being their responsibility or fault. They will never feel badly about something they’ve done. Sometimes they will act as if they feel badly and say they are sorry but only if they think it will get them out of trouble. Manipulation tactic. One of our adopted RAD’s is back in his home country. He messages me and tells me he is sorry for molesting our 15-year-old daughter. Then he asks me to help him get back to America. One time I flat out said to him that the only reason he was saying he was sorry was so that I would help him. He agreed then asked if I would help him anyway.

Abnormal eating patterns. They can eat enormous amounts of food or no food at all for days. They will eat strange combinations like an entire container of sour cream with a cup of sugar on top. They will ask for a certain food and once made will refuse to eat it telling you it looks like garbage. They will steal food from a local store and we’ll find it rotting, uneaten, in their room. If you put something in front of them they don’t like that day (they liked it last week) they will spit on it and me, asking why I feed them such garbage. (This is homemade from scratch food.) They will take the sandwich made with homemade bread and throw it in the garbage at school and then tell everyone we are starving them. We will wake up one morning and find the refrigerator was cleaned out of all the food we planned to serve that day. Later we’ll find empty containers in their room and uneaten food smashed under their mattress.

Poor peer relationships. Making friends for most RAD’s is literally impossible. It goes back to it’s all about them. No one, even another small child who starts out as a friend, will put up with that behavior for long. RAD will keep up the relationship as long as there is something in it for them. After that they will walk away without a second thought. Our RAD’s even turned on each other when it suited them. There is no loyalty. And zero understanding when RAD tries to rekindle the relationship and the other person wants nothing to do with RAD. RAD doesn’t comprehend that it was them that ruined the relationship and the other person doesn’t want to get burned a second time.

Preoccupation with fire. Constant talk of burning down the house, burning the car, burning everything meaningful to the family, and even burning the house with the family inside. Playing with matches and lighters. Drawing vivid pictures of burning buildings. Filling trash cans with combustibles and lighting them on fire. There are numerous stories of homes being burned to the ground by their RAD child or teen. Fire and RAD are a dangerous mixture.

Preoccupation with blood and gore. If RAD is not watching porn on their (stolen) phone they will migrate to the most violent shows possible. They spend hours watching the news and the worse it is the more they are enthralled with it. A fellow adoptive mom said that her RAD daughter would only watch the beginning of a particular show because she liked watching the murder happen. The mom said she liked watching the criminals get caught and brought to justice. RAD said, “That’s boring.” They will draw pictures with lots of blood and scenes of murder. One mom found a picture drawn by RAD daughter of RAD standing over the mom while mom was sleeping with a bloody red knife in her hands and blood all over the room.

Preoccupation with bodily functions. Painting with feces is common. There are even groups on social media where this is their main focus it is so common. Urinating on things of importance, into heating vents, and on furniture and even walls to ruin them. However, this bodily function doesn’t mean they have good hygiene and in most cases they have just the opposite. They will refuse to take showers or wash their hair. If they smell at school please know we do our best to make them wash but I cannot go into a shower with an older child or teenager to make sure they wash with soap and water.

Persistent nonsense questions, chatter, and senseless noises. Non-stop questions about mindless things. Constant “why” questions where they don’t care one bit about the answer but are just taking up your time. They want to be the center of attention at all times. And if it’s not questions it is meaningless chatter or noise. Imagine someone who refuses to get more than two feet from you who constantly clicks their tongue over and over for five or six hours just because they know it makes you crazy. And if you ask them to stop, they just do it louder because they know they are achieving their goal. Or how about listening to non-stop screaming. They scream until they can’t scream anymore because they lose their voice. Once healed they start screaming all over again.

Non-stop demanding of attention. RAD must be the center of attention at all times. If someone or something else has your attention they will force themselves between in any way they can. One dad told this story. He was playing cards with another child at the kitchen table. RAD attempted to sit on dad’s lap – this is a 16-year-old male – and when that didn’t work he pulled up a chair so close it was touching dad’s chair and leaned heavily against dad, talking constantly and disrupting through the entire game and even putting his feet up on the table, asking dad to rub his feet. AND this was AFTER dad asked RAD to play the game with him and RAD retorted with profanity that he hates playing games and stomped off to his room. It was only after dad started playing with the other child that RAD became interested.

Triangulation of adults. I wrote several sections in Adoption Combat Zone on triangulation. Most times this is pitting dad against mom but triangulation can occur with any adult who the RAD can manipulate including fellow church members, teachers, neighbors, extended family members, etc. The goal for the RAD is to manipulate someone to take their side in things. Triangulation occurs when RAD is allowed to come between adults. To one side they show their worst and the other, only their best. One person sees a sweet, adorable, perfect child/teen, the other sees someone who is trying to destroy them through whatever means possible. All this is done in order to get the life the RAD wants, one where they are in total control.

False allegations of abuse. This is more common than any sane person would think and I’ve written much about it in the book. This is the number one go-to for RAD’s to get back at anyone who is not giving them what they want or to try and get what they want. We were turned into the authorities by our RAD’s several times for made-up abuses simply for not allowing them to keep a phone they stole and sit up all night watching porn on said phone. Mad at it being taken away they went to school the next day and reported us for abuse. Or when they feel threatened because they were caught doing something wrong they will turn in someone else in order to take the heat off themselves. They are fantastic story tellers.

Creating chaos. RAD’s are experts at creating commotion so they can be the center of attention whether it be something like the dad playing a game above or something more serious such as starting a fire in your kitchen so they can go through your purse to steal your cash and credit cards. They will disrupt family dinners and outings. They love arguing and the louder it gets, the better.

DEFINITIONS

MAYO CLINIC

Overview

Reactive attachment disorder is a rare but serious condition in which an infant or young child doesn’t establish healthy attachments with parents or caregivers. Reactive attachment disorder may develop if the child’s basic needs for comfort, affection and nurturing aren’t met and loving, caring, stable attachments with others are not established.

With treatment, children with reactive attachment disorder may develop more stable and healthy relationships with caregivers and others. Treatments for reactive attachment disorder include psychological counseling, parent or caregiver counseling and education, learning positive child and caregiver interactions, and creating a stable, nurturing environment.

Symptoms

Reactive attachment disorder can start in infancy. There’s little research on signs and symptoms of reactive attachment disorder beyond early childhood, and it remains uncertain whether it occurs in children older than 5 years.

Signs and symptoms may include:

Unexplained withdrawal, fear, sadness or irritability

Sad and listless appearance

Not seeking comfort or showing no response when comfort is given

Failure to smile

Watching others closely but not engaging in social interaction

Failing to ask for support or assistance

Failure to reach out when picked up

No interest in playing peekaboo or other interactive games

When to see a doctor

Consider getting an evaluation if your child shows any of the signs above. Signs can occur in children who don’t have reactive attachment disorder or who have another disorder, such as autism spectrum disorder. It’s important to have your child evaluated by a pediatric psychiatrist or psychologist who can determine whether such behaviors indicate a more serious problem.

Causes

To feel safe and develop trust, infants and young children need a stable, caring environment. Their basic emotional and physical needs must be consistently met. For instance, when a baby cries, the need for a meal or a diaper change must be met with a shared emotional exchange that may include eye contact, smiling and caressing.

A child whose needs are ignored or met with a lack of emotional response from caregivers does not come to expect care or comfort or form a stable attachment to caregivers.

It’s not clear why some babies and children develop reactive attachment disorder and others don’t. Various theories about reactive attachment disorder and its causes exist, and more research is needed to develop a better understanding and improve diagnosis and treatment options.

Risk factors

The risk of developing reactive attachment disorder from serious social and emotional neglect or the lack of opportunity to develop stable attachments may increase in children who, for example:

Live in a children’s home or other institution

Frequently change foster homes or caregivers

Have parents who have severe mental health problems, criminal behavior or substance abuse that impairs their parenting

Have prolonged separation from parents or other caregivers due to hospitalization

However, most children who are severely neglected don’t develop reactive attachment disorder.

Complications

Without treatment, reactive attachment disorder can continue for several years and may have lifelong consequences.

Some research suggests that some children and teenagers with reactive attachment disorder may display callous, unemotional traits that can include behavior problems and cruelty toward people or animals. However, more research is needed to determine if problems in older children and adults are related to experiences of reactive attachment disorder in early childhood.

Prevention

While it’s not known with certainty if reactive attachment disorder can be prevented, there may be ways to reduce the risk of its development. Infants and young children need a stable, caring environment and their basic emotional and physical needs must be consistently met. The following parenting suggestions may help.

Take classes or volunteer with children if you lack experience or skill with babies or children. This will help you learn how to interact in a nurturing manner.

Be actively engaged with your child by lots of playing, talking to him or her, making eye contact, and smiling.

Learn to interpret your baby’s cues, such as different types of cries, so that you can meet his or her needs quickly and effectively.

Provide warm, nurturing interaction with your child, such as during feeding, bathing or changing diapers.

Offer both verbal and nonverbal responses to the child’s feelings through touch, facial expressions and tone of voice.

Diagnosis

A pediatric psychiatrist or psychologist can conduct a thorough, in-depth examination to diagnose reactive attachment disorder.

Your child’s evaluation may include:

Direct observation of interaction with parents or caregivers

Details about the pattern of behavior over time

Examples of the behavior in a variety of situations

Information about interactions with parents or caregivers and others

Questions about the home and living situation since birth

An evaluation of parenting and caregiving styles and abilities

Your child’s doctor will also want to rule out other psychiatric disorders and determine if any other mental health conditions co-exist, such as:

Intellectual disability

Other adjustment disorders

Autism spectrum disorder

Depressive disorders

Diagnostic and Statistical Manual of Mental Disorders (DMS-5)

Your doctor may use the diagnostic criteria for reactive attachment disorder in the DSM-5, published by the American Psychiatric Association. Diagnosis isn’t usually made before 9 months of age. Signs and symptoms appear before the age of 5 years.

Criteria include:

A consistent pattern of emotionally withdrawn behavior toward caregivers, shown by rarely seeking or not responding to comfort when distressed

Persistent social and emotional problems that include minimal responsiveness to others, no positive response to interactions, or unexplained irritability, sadness or fearfulness during interactions with caregivers

Persistent lack of having emotional needs for comfort, stimulation and affection met by caregivers, or repeated changes of primary caregivers that limit opportunities to form stable attachments, or care in a setting that severely limits opportunities to form attachments (such as an institution)

No diagnosis of autism spectrum disorder

Treatment

Children with reactive attachment disorder are believed to have the capacity to form attachments, but this ability has been hindered by their experiences.

Most children are naturally resilient. And even those who’ve been neglected, lived in a children’s home or other institution, or had multiple caregivers can develop healthy relationships. Early intervention appears to improve outcomes.

There’s no standard treatment for reactive attachment disorder, but it should involve both the child and parents or primary caregivers. Goals of treatment are to help ensure that the child:

Has a safe and stable living situation

Develops positive interactions and strengthens the attachment with parents and caregivers

Treatment strategies include:

Encouraging the child’s development by being nurturing, responsive and caring

Providing consistent caregivers to encourage a stable attachment for the child

Providing a positive, stimulating and interactive environment for the child

Addressing the child’s medical, safety and housing needs, as appropriate

Other services that may benefit the child and the family include:

Individual and family psychological counseling

Education of parents and caregivers about the condition

Parenting skills classes

Controversial and coercive techniques

The American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association have criticized dangerous and unproven treatment techniques for reactive attachment disorder.

These techniques include any type of physical restraint or force to break down what’s believed to be the child’s resistance to attachments — an unproven theory of the cause of reactive attachment disorder. There is no scientific evidence to support these controversial practices, which can be psychologically and physically damaging and have led to accidental deaths.

If you’re considering any kind of unconventional treatment, talk to your child’s psychiatrist or psychologist first to make sure it’s evidence based and not harmful.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Coping and support

If you’re a parent or caregiver whose child has reactive attachment disorder, it’s easy to become angry, frustrated and distressed. You may feel like your child doesn’t love you — or that it’s hard to like your child sometimes.

These actions may help:

Educate yourself and your family about reactive attachment disorder. Ask your pediatrician about resources or check trusted internet sites. If your child has a background that includes institutions or foster care, consider checking with relevant social service agencies for educational materials and resources.

Find someone who can give you a break from time to time. It can be exhausting caring for a child with reactive attachment disorder. You’ll begin to burn out if you don’t periodically have downtime. But avoid using multiple caregivers. Choose a caregiver who is nurturing and familiar with reactive attachment disorder or educate the caregiver about the disorder.

Practice stress management skills. For example, learning and practicing yoga or meditation may help you relax and not get overwhelmed.

Make time for yourself. Develop or maintain your hobbies, social engagements and exercise routine.

Acknowledge it’s OK to feel frustrated or angry at times. The strong feelings you may have about your child are natural. But if needed, seek professional help.

Preparing for your appointment

You may start by visiting your child’s pediatrician. However, you may be referred to a child psychiatrist or psychologist who specializes in the diagnosis and treatment of reactive attachment disorder or a pediatrician specializing in child development.

Here’s some information to help you get ready and know what to expect from your doctor.

What you can do

Before your appointment, make a list of:

Any behavior problems or emotional issues you’ve noticed, and include any signs or symptoms that may seem unrelated to the reason for your child’s appointment

Key personal information, including any major stresses or life changes that you or your child have been through

All medications, vitamins, herbal remedies or other supplements your child is taking, including the dosages

Questions to ask your child’s doctor to make the most of your time together

RadKid.Org : Provides information and resources for caregivers of children with reactive attachment disorder in particular, but also includes descriptions of other childhood emotional, behavioral, or developmental disorders.

ADSG : Attachment Disorder Support Group – Information and resources relating to reactive attachment disorder, from a Christian perspective.

RadKid.Org : Reactive Attachment Disorder – Moderated by the folks at radkid.org & radkid.com, this is a support forum for parents, caregivers, therapists, and others concerned with reactive attachment disorder. Access is free, but requires registration with Delphi Forums.

Forest Cottage Centre : Provides specialized coaching for parents of children with attachment disorder by telephone and through in-person sessions. Tanya Helton M/Sc is a well-known speaker in Canada on the issue of attachment, providing training for parents and professionals. Located in Fort St. John, British Columbia, Canada.

ATTACh : Association for the Treatment and Training in Attachment of Children – International coalition of professionals and lay persons who are involved with children who have attachment disorders. Includes a list of member therapists and treatment centers.

The Attachment Disorder Site : Information and resources for parents and caregivers of children with attachment disorder. Find information about the effects of RAD on children and adults, some suggestions on dealing with schools and teachers, as well as adoption information.

Hope for Radkids : Moderated by Nancy Geoghegan, this is a long-running and active support group for caregivers of children with reactive attachment disorder. Hosted on Yahoo Groups, this site requires registration, but access is free.

St. Louis Attachment Network : Provides information, education, and support to families in the St. Louis, Missouri area. Includes a meeting schedule.

Nancy Thomas Parenting : A not-for-profit service organization offering information and resources on reactive attachment disorder directed at parents and teachers. Includes a schedule of seminars. The author of at least two books on the subject, Nancy L. Thomas is a Therapeutic Parenting Specialist.

Daniel A. Hughes : Offers consultation and training for therapists and parents. The author of at least two books on the subject, Dr. Hughes has specialized in the treatment of children with emotional deficit, and now conducts workshops and trains therapists throughout the country. Includes a schedule of workshops.

ADSG : Attachment Disorder Support Group : Includes forums for general RAD support, for homeschooling or other school issues, for adults with RAD and for siblings of children with RAD. No registration required.

WNC Families CAN : Provides information and support for families in the Ashville, North Carolina area. No online discussion forum, but you can find a meeting schedule.

Center for Family Development : Presents information about reactive attachment disorder and other developmental / emotional deficits, including interesting testimonials from patients who have healed.

RadZebra.Org : Attachment Disorder Network – Offers information and resources for parents and caregivers of children with RAD, as well as articles and poems. Includes a regular-mail newsletter and a support group for those in the Kansas City, Missouri area.

The Little Prince : Surviving Life with Reactive Attachment Disorder – A mother’s experiences raising a RAD child. The author offers information about attachment parenting, dealing with this difficult subject with humor and poetry.

MSN Groups: Reactive Attachment Disorder : Online support and discussion group for parents, caregivers, and others concerned with attachment disorder, therapeutic parenting and the treatment of bonding disorders.